Suture-based closure with hemostatic tract plug

ABSTRACT

Devices for closing a passage through tissue communicating with a body lumen. The device may include an elongate body, a sheath disposed at the distal end of the device for disposition within a body lumen, a hollow needle disposed within a needle lumen of the body, the needle being selectively advanceable through the needle lumen, a suture-anchor ejection mandrel disposed within the hollow needle that is also selectively advanceable through the hollow needle, a suture-anchor and suture disposed within the hollow needle, a distal end of the suture attached to the suture anchor for ejection out the hollow needle by the mandrel. A needle guide disposed between the sheath and proximal end of the body may include a needle port through which the needle can exit. A hemostatic plug is disposed over the needle port so as to be penetrated by the needle upon exiting the port.

CROSS-REFERENCE TO RELATED APPLICATIONS

This is a continuation application of U.S. patent application Ser. No.15/697,842, filed Sep. 7, 2017, entitled “Suture-Based Closure withHemostatic Track Plug,” now U.S. Pat. No. 10,806,439, which is acontinuation application of U.S. patent application Ser. No. 15/090,247,filed Apr. 4, 2016, entitled “Suture-Based Closure with Hemostatic TrackPlug”, now U.S. Pat. No. 9,757,108, which is a continuation applicationof U.S. patent application Ser. No. 14/052,654, filed Oct. 11, 2013,U.S. Pat. No. 9,301,746, entitled “Suture-Based Closure with HemostaticTrack Plug”, the disclosures of which are incorporated herein by thisreference.

BACKGROUND

The present invention relates generally to apparatus and methods for theclosing of an access passage opened within a body lumen. Moreparticularly, the present invention relates to techniques forpercutaneous closure of arterial and venous puncture sites, which areusually accessed through a tissue tract.

A number of diagnostic and interventional vascular procedures are nowperformed translumenally. A catheter is introduced to the vascularsystem at a convenient access location and guided through the vascularsystem to a target location using established techniques. Suchprocedures require vascular access, which is usually established duringthe well-known Seldinger technique. Vascular access is generallyprovided through an introducer sheath, which is positioned to extendfrom outside the patient body into the vascular lumen.

When vascular access is no longer required, the introducer sheath isremoved and bleeding at the puncture site stopped. One common approachfor providing hemostasis (the cessation of bleeding) is to applyexternal force near and upstream from the puncture site, typically bymanual or “digital” compression. This approach suffers from a number ofdisadvantages. It is time consuming, frequently requiring one-half houror more of compression before hemostasis is assured. Additionally, suchcompression techniques rely on clot formation, which can be delayeduntil anticoagulants used in vascular therapy procedures (such as forheart attacks, stent deployment, non-optical PTCA results, and the like)wear off. This can take two to four hours, thereby increasing the timerequired before completion of the compression technique. The compressionprocedure is further uncomfortable for the patient and frequentlyrequires analgesics to be tolerable. Moreover, the application ofexcessive pressure can at times totally occlude the underlying bloodvessel, resulting in ischemia and/or thrombosis. Following manualcompression, the patient typically remains recumbent from four to asmuch as twelve hours or more under close observation so as to assurecontinued hemostasis. During this time renewed bleeding may occur,resulting in blood loss through the tract, hematoma and/orpseudo-aneurysm formation, as well as arteriovenous fistula formation.These complications may require blood transfusion and/or surgicalintervention.

The incidence of complications from compression-induced hemostasisincreases when the size of the introducer sheath grows larger, and/orwhen the patient is anticoagulated. It is clear that the compressiontechnique for arterial closure can be risky, and is expensive andonerous to the patient. Although the risk of complications can bereduced by using highly trained individuals, dedicating such personnelto this task is both expensive and inefficient. Nonetheless, as thenumber and efficacy of translumenally performed diagnostic andinterventional vascular procedures increases, the number of patientsrequiring effective hemostasis for a vascular puncture continues toincrease.

While other techniques, including use of fasteners, suturing, etc. havebeen proposed, existing approaches continue to exhibit limitations. Forexample, effective suture based vessel closure can be difficult due tothe need to target suture capture for retrieval through the artery orother body lumen wall, which requires complicated mechanisms, such asthat described in U.S. Publication 2009/0088779, herein incorporated byreference. In addition, a high level of practitioner skill is needed tomaintain proper suture deployment angles for suture delivery andharvest. Even when performed properly, such procedures may still resultin minor oozing from the access tract. The present disclosure addressesat least some of the presently existing disadvantages.

BRIEF SUMMARY

The present disclosure describes devices, systems, and methods forclosing an access passage through tissue communicating with a bodylumen. The device may include an elongate device body extending from aproximal end to a distal end, a sheath disposed at the distal end of thedevice for disposition within a body lumen during use, and at least onehollow needle disposed within a corresponding needle lumen of theelongate body. The hollow needle is advanceable through the needlelumen. A suture-anchor ejection mandrel is disposed within the hollowneedle, which mandrel is also selectively advanceable through the hollowneedle. A suture-anchor and suture may be disposed within the hollowneedle, a distal end of the suture being attached to the suture-anchorfor ejection out a distal end of the hollow needle by the mandrel.

The device may further comprise a needle guide disposed between thesheath and the proximal end of the device body. The needle guide mayinclude a needle port corresponding to each hollow needle through whichthe hollow needles may exit the device during use. A hemostatic plug maybe disposed over the needle port, within a receiving recess disposedabout each needle port. As a result, the hemostatic plug may bepenetrated by the hollow needle upon its exit through the needle port.The device may further comprise a needle advancement assembly disposedon or within the elongate body configured to selectively advance anddeploy the hollow needle through the needle port and into tissueadjacent the access passage during use. A suture-anchor ejectionassembly disposed on or within the elongate body may be configured toselectively advance the suture-anchor ejection mandrel so as to ejectthe suture-anchor from the hollow needle into the body lumen (e.g., anartery) at a location adjacent a wall of the body lumen in preparationfor closing the access passage.

In another embodiment, the device may include an elongate device bodyextending from a proximal end to a distal end, a sheath disposed at thedistal end of the device for disposition within a body lumen during use,and a pair of hollow needles disposed within corresponding needle lumensof the elongate body. Each hollow needle is advanceable through acorresponding one of the needle lumens. A suture-anchor ejection mandrelis disposed within each hollow needle, each mandrel being selectivelyadvanceable through its corresponding hollow needle. A suture-anchor andsuture may be disposed within each hollow needle, a distal end of eachsuture being attached to the suture-anchor for ejection out a distal endof the corresponding hollow needle by its corresponding mandrel.

The device may further comprise a needle guide disposed between thesheath and the proximal end of the device body. The needle guide mayinclude a pair of needle ports, each port corresponding to a hollowneedle through which the corresponding hollow needle may exit duringuse. Hemostatic plugs may be disposed over the needle ports, withinreceiving recesses disposed about each needle port so as to bepenetrated by a corresponding hollow needle upon advancement. The devicemay further comprise a needle advancement assembly disposed on or withinthe elongate body configured to selectively deploy the hollow needlesthrough the needle ports and into tissue adjacent the access passageduring use. A suture-anchor ejection assembly disposed on or within theelongate body may be configured to selectively advance the suture-anchorejection mandrels so as to eject the suture-anchors from the hollowneedles and into the body lumen (e.g., an artery) at locations adjacenta wall of the body lumen in preparation for closing the access passage.

In another embodiment, the device may include an elongate device bodyextending from a proximal end to a distal end, a sheath disposed at thedistal end of the device for disposition within a body lumen during use,and a pair of hollow needles (an anterior needle and a posterior needle)disposed within corresponding needle lumens of the elongate body. Eachhollow needle is advanceable through a corresponding one of the needlelumens. A pair of suture-anchor ejection mandrels are also provided,with a mandrel disposed within each hollow needle, each mandrel beingselectively advanceable through its corresponding hollow needle. Asuture-anchor and suture may be disposed within each hollow needle, adistal end of each suture being attached to the suture-anchor forejection out a distal end of the corresponding hollow needle by itscorresponding mandrel.

The device may further comprise a needle guide disposed between thesheath and the proximal end of the device body. The needle guide mayinclude anterior and posterior needle ports through which thecorresponding anterior and posterior hollow needles may exit upon theiradvancement during use. The anterior needle port may be disposedanterior (i.e., distally) relative to the posterior needle port alongthe needle guide. Hemostatic plugs may be disposed over each needleport, within receiving recesses disposed about each needle port so as tobe penetrated by a corresponding hollow needle upon advancement. Thedevice may further comprise a needle advancement assembly disposed on orwithin the elongate body configured to selectively deploy the hollowneedles through the needle ports and into tissue adjacent the accesspassage during use. A suture-anchor ejection assembly disposed on orwithin the elongate body may be configured to selectively advance thesuture-anchor ejection mandrels so as to eject the suture-anchors fromthe hollow needles into the body lumen, to locations adjacent a wall ofthe body lumen in preparation for closing the access passage.

The needle advancement assembly, the suture-anchor ejection assembly,the suture-anchor ejection mandrels, and the hollow needles may betogether detachable from the distal end of the device body to allow auser to remove these proximally disposed structures once suture-anchorshave been deployed and set, providing the practitioner with easy accessto the remaining device structure and the proximal ends of the suturesin preparation for closing the access passage.

These and other objects and features of the present disclosure willbecome more fully apparent from the following description and appendedclaims, or may be learned by the practice of the embodiments of theinvention as set forth hereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS

To further clarify the above and other advantages and features of thepresent disclosure, a more particular description of the invention willbe rendered by reference to specific embodiments thereof which areillustrated in the appended drawings. It is appreciated that thesedrawings depict only illustrated embodiments of the invention and aretherefore not to be considered limiting of its scope. Embodiments of theinvention will be described and explained with additional specificityand detail through the use of the accompanying drawings in which:

FIG. 1 is an isometric view of an exemplary closure device according toan embodiment of the present disclosure;

FIG. 2 is a close-up view showing the distal sheath and needle guide ofthe device of FIG. 1 ;

FIG. 3A is an isometric view of the device of FIG. 1 , showingactivation of the needle advancement assembly and associated deploymentof the hollow needles through the needle ports;

FIG. 3B is an isometric view of the device of FIG. 3A, showingactivation of the suture-anchor ejection assembly and associateddeployment of the suture-anchor out the distal end of the hollowneedles;

FIG. 4 is a transverse cross-sectional view through the needle guideportion of the device of FIG. 1 ;

FIG. 5A is a close-up isometric view showing the portion of the needleguide surrounding a needle port and hemostatic plug;

FIG. 5B is a cross-sectional view through the portion of the needleguide shown in 5A;

FIG. 5C is a close-up isometric view similar to that of FIG. 5A, showinga portion of the needle guide surrounding a needle port, but in whichthe hemostatic plug has been removed so as to more clearly show theneedle port and surrounding receiving recess into which the hemostaticplug is received;

FIGS. 6A-6E illustrate a method for use of the closure device in placingsutures and hemostatic plugs in preparation for closing the accesstract;

FIGS. 7A-7B illustrate progressive removal of the device from an accesstract in preparation for closure of the access tract with the suturesand hemostatic plugs once the sutures have been set;

FIGS. 8A-8C illustrate how the sutures may include barbs to resistmovement of the hemostatic plug once the barbed suture engages the plug;and

FIGS. 9A-9B illustrate tying and sliding of a surgical sliding knotformed with the suture legs to close the access tract, the hemostaticplugs engaged by the suture legs providing a secondary sealing mechanismfor ensuring effective closure of the access tract.

DETAILED DESCRIPTION

I. Introduction

In one aspect, the present disclosure describes devices for closing anaccess tract or passage through tissue communicating with a body lumen.The device may include an elongate body extending from a proximal end toa distal end, a sheath disposed at the distal end of the device fordisposition within a body lumen during use, at least one hollow needledisposed within a corresponding needle lumen of the body, at least onesuture-anchor ejection mandrel disposed within the hollow needle, asuture-anchor and suture disposed within the hollow needle, a needleguide including a needle port disposed between the sheath and proximalend of the elongate body, a hemostatic plug disposed over the needleport, within a receiving recess disposed about the needle port, andadvancement and ejection assemblies on or within the elongate body fordeploying the hollow needle(s) and ejecting the suture-anchor ejectionmandrel, respectively.

Each suture-anchor ejection mandrel is disposed within a correspondinghollow needle so that both the needle(s) and mandrel(s) are selectivelyadvanceable upon activation of the associated advancement and ejectionassemblies, respectively. The hollow needle can advance through theneedle lumen in the elongate body, so as to exit through the needle portof the needle guide, while the mandrel is selectively advanceable withinthe hollow needle, so as to allow the suture-anchor stored therein to beejected out, when desired. The hemostatic plugs are disposed over theneedle port(s) so that when exiting the needle port, a respective hollowneedle penetrates the hemostatic plug disposed thereover. Thesuture-anchor may be pushed out distal end of the hollow needle, whilethe suture attached to the suture-anchor trails behind, inside thehollow needle. Upon retraction of the hollow needle and mandrel (whilethe suture-anchor and suture remain in place), the suture and plugbecome engaged together.

An exemplary device may include two hollow needles, and two associatedmandrels, needle ports, hemostatic plugs, suture-anchors, and sutures.The device allows a practitioner to position the device within thepassage to be closed, the hollow needles are advanced, penetrating thehemostatic plug and into tissue surrounding the access tract,penetrating into the artery or other body lumen. The mandrels are thenadvanced, ejecting the suture-anchors through the hollow needles intothe artery or other body lumen. The suture anchors may be positionedadjacent the wall of the body lumen by tensioning the proximal end ofeach suture, so as to “set” the suture-anchors in a desired position(e.g., one suture-anchor on either side of the opening). The proximal“back end” portion of the device, including the hollow needles andmandrels may then be withdrawn, providing engagement between the suturesand the hemostatic plugs (e.g., within the access passage) as the plugsclose about the suture as the needle is withdrawn and the suture remainsin place. The distal “front end” portion of the device may be partiallywithdrawn to the point that the sheath continues to provide hemostasisof the opening, and the sutures may then be tied down. Because thesuture legs include the hemostatic plugs engaged therewith, as thesuture legs are tied down over the access opening, the hemostatic plugsprovide additional sealing of the opening beyond that provided bysuturing alone.

Where two or more suture-anchors are deployed (e.g., one on each side ofthe opening) through a corresponding number of hollow needles, closureof the opening is more effective than methods that deliver only a singlefastener, plug, or suture (e.g., centered over the opening). Whendelivering such fasteners, plugs, etc. over the opening, it can bedifficult to ensure that the fastener or plug is properly placed.Locating the plug or fastener too far from the interface of overlyingtissue and the adventitial surface of the blood vessel or other bodylumen can result in failure to provide hemostasis and other problems. Itis also possible that the fastener or plug may undesirably intrude intothe body lumen, resulting in intravascular clots and other problems.

In addition, as compared to existing closure techniques that deliver asuture so as to cross the opening (e.g., using dual needles), thepresent techniques are simpler, as it is not necessary to retrieve thedistal end of the suture once it is delivered through the wall of thebody lumen. This results in a significantly simpler closure techniquethat can be practiced without the high level of practitioner skillneeded to maintain proper suture deployment angles for delivery andsubsequent retrieval. The use of suture-anchors attached to the distalend of the sutures allows them to be delivered to opposing sides of theopening (no retrieval needed), after which the proximal ends of thesutures may be tied together, forming a closing seal over the opening.Because the suture legs include hemostatic plugs engaged or anchoredthereto, the plugs aid in ensuring that an effective seal is formed,which may effectively reduce or eliminate tract ooze from the accesssite.

While the suture-anchors may remain within the body lumen followingclosure, they may be formed of a rapidly-eroding material that dissolveswithin the body lumen within a matter of hours.

II. Exemplary Devices and Methods

Referring to FIG. 1 , an isometric view of an example of a device 100for closing an access passage through tissue that embodies features ofthe invention is illustrated. Device 100 may include an elongate body102 extending from a proximal end 104 to a distal end 106. A sheath 108may be disposed at distal end 106 of device 100 for disposition into abody lumen (e.g., an artery) during use. Device 100 may further includea needle guide 110 disposed between sheath 108 and the proximal end 104of body 102. Needle guide 110 may be considered part of elongate body102.

Disposed on or within device 100 are various structures that aid indelivering a suture to close the access passage. Some such structuresdiscussed below may perhaps be best seen in FIG. 4 , showing atransverse cross-section through needle guide 110. At least one hollowneedle (e.g., anterior and posterior needles 112 a and 112 b) may bedisposed within a corresponding needle lumen (e.g., lumens 114 a, 114 b)of needle guide 110. Such needle lumens may extend proximally fromneedle guide 110 into the proximal portions of body 102. At least onesuture-anchor ejection mandrel (e.g., anterior and posterior mandrels116 a and 116 b) may be disposed within the hollow needle(s). The one ormore hollow needles (e.g., 112 a, 112 b) are selectively advanceablethrough the needle lumens 114 a, 114 b. The one or more mandrels (e.g.,116 a, 116 b) are selectively advanceable through the correspondinghollow needles (e.g., 112 a, 112 b) within which they are disposed. Asuture-anchor and corresponding suture (e.g., sutures 118 a, 118 b) mayalso be disposed within the at least one hollow needle. A distal end ofthe suture may be attached to the suture-anchor so that when thesuture-anchor is ejected out the distal end of a given hollow needle bythe corresponding suture-anchor ejection mandrel, the attached suturemay trail behind. In the illustrated embodiment, sutures 118 a and 118 bare shown received within a channel formed in mandrels 116 a, 116 b,although other configurations may of course be employed. For example, inanother embodiment, the suture may be disposed within a groove formed inthe exterior surface of mandrel 116 a, 116 b, a groove formed into aninterior surface of hollow needle 112 a, 112 b, or simply disposedwithin a clearance space provided between mandrel 116 a, 116 b andcorresponding hollow needle 112 a, 112 b. Other configurations may alsobe suitable for use. As shown in FIG. 1 , the proximal end of the suturelegs may reside and be stored within body 102 and/or suture lumens 111.

In an embodiment, sutures 118 a, 118 b may have a diameter from about0.005 inch to about 0.015 inch (e.g., about 0.009 inch). Needle guide110 may have a diameter from about 0.08 inch to about 0.15 inch (e.g.,about 0.114 inch).

Needle guide 110 includes at least one needle port through which thehollow needles exit during use. For example, in the illustratedconfiguration, two needle ports 120 a and 120 b may be provided, throughwhich anterior hollow needle 112 a and posterior needle 112 b,respectively, may exit or protrude when needles 112 a, 112 b aredeployed. FIG. 3A shows activation of a needle advancement assembly(e.g., a plunger, mandrel, or other mechanism operatively couplingneedle advancement lever 122 with needles 112 a, 112 b), causing hollowneedles 112 a and 112 b to be advanced distally, deploying throughneedle ports 120 a and 120 b. Because of placement of hemostatic plugs124 a and 124 b over ports 120 a and 120 b, needles 112 a, 112 bpenetrate plugs 124 a, 124 b upon such advancement.

As seen in FIG. 3B, upon activation of a suture-anchor ejection assembly(e.g., a coupling mechanism operatively coupling suture-anchor ejectionlever 123 with mandrels 116 a, 116 b), mandrels 116 a, 116 b areadvanced within hollow needles 112 a, 112 b, pushing the suture-anchorahead of the respective mandrel, eventually pushing suture-anchors 125a, 125 b out of hollow needles 112 a, 112 b, clear of plugs 124 a, 124b.

Device 100 further includes at least one hemostatic plug disposed overthe one or more needle ports (e.g., positioned within a receiving recessdisposed about the needle port(s). Illustrated device 100 includes twohemostatic plugs 124 a and 124 b, disposed over needle ports 120 a and120 b, within recesses 126 a and 126 b. FIGS. 5A-5C show close-up viewsof needle guide 110 in the region surrounding hemostatic plugs 124 a,124 b, ports 120 a, 120 b, and receiving recesses 126 a, 126 b.

As shown in FIG. 5A, hemostatic plug 124 a may be initially retainedwithin receiving recess 126 a through any suitable mechanism. In anembodiment, one or more mechanical retention mechanisms such as détentes123 or other overhanging structure may aid in initially retaining plug124 within recess 126 a. For example, one or more protrusions andcorresponding mating recesses may be provided within the retainingrecess and hemostatic plug received therein for inhibiting prematuredislodgement of the hemostatic plug. In an embodiment, the bottom ofreceiving recess 126 a might include protrusions (e.g., including abulbous head with an undercut) or recesses (e.g., oppositely configuredwith an undercut) in which portions of the plug 124 a may reside,resulting in increased retention of the plug. Where the plug is a highlyflexible putty-like material (e.g., collagen), it may easily adapt intoand around such undercuts or other features configured to increaseretention force. In another embodiment, a weak adhesive may be appliedbetween the recess 126 a and plug 124 a to help hold it in place. In anycase, the retention force exhibited by the arrangement may be such thatthe plug is dislodged from recess 126 a upon penetration of plug 124 aby needle 112 a so that upon subsequent withdrawal of needle 112 a, plug124 a is dislodged from recess 126 a, becoming engaged with suture 118a. While described in the context of hemostatic plug 124 a, it will beunderstood that hemostatic plug 124 b may be similarly configured.

As seen in FIG. 5B, ports 120 a and 120 b may be longitudinally offsetrelative to one another such that one port (e.g., port 120 a) may bedisposed anteriorly or distally relative to the other port (e.g., port120 b). Associated structures (e.g., hemostatic plugs 124 a, 124 b, andreceiving recesses 126 a, 126 b may similarly be longitudinally offsetas shown in the figures.

Needle lumen 114 a guides hollow needle 112 a to exit port 120 a at anangle. For example, the distal portion of needle lumen 114 a adjacentport 120 a may be ramped, as perhaps best seen in FIG. 5B to bias needle112 a to a desired angle relative to the longitudinal axis of needleguide 110, forcing hollow needle 112 a to penetrate the tissue adjacentthe access passageway during use. Such angle may typically be from about5° to about 60°, from about 10° to about 45°, or from about 15° to about35°. Needle lumen 114 b may be similarly configured to provide anopposite guiding angle, forcing one hollow needle to penetrate to oneside of the access passage, while the other needle penetrates to theother side of the access passage, as shown in FIG. 6C.

Additional details of various needle guide and needle configurations aredisclosed in U.S. Publication 2009/0088779 which describes suturedelivery and retrieval systems including needle deployment to eitherside of an access opening. The above application describesconfigurations that employ an articulating foot into which the needlesare received during use. The presently described embodiments rather donot require the use of an articulating foot or any associated controllumen. Rather, the needle guide and sheath portions disposed distal tothe receiving recesses 126 a, 126 b and ports 120 a, 120 b may besubstantially smooth, without the need for any such articulating foot.U.S. Publication 2009/0088779 is herein incorporated by reference in itsentirety.

FIGS. 6A-9B illustrate an example of a method for closing an accesspassageway using device 100. As seen in FIG. 6A, catheter sheath 108 isbackloaded over guide wire 128. Sheath 108 and device 100 may beadvanced through access tract 130 until guide wire 128 emerges atmonorail port 132 (monorail port 132 may be seen in FIG. 1 ), withsheath 108 positioned within body lumen 134. Monorail port 132 may allowwithdrawal of guide wire 128 from body lumen 134 (e.g., an artery) inpreparation for closure of access tract or passageway 130. Device 100,including sheath 108 may be advanced within access passageway 130 untilmarker port 136 is positioned within body lumen 134. Indication thatmarker port 136 is properly positioned may be indicated by a strongpulsatile flow of blood out marker lumen 138, as seen in FIG. 6B. It isat this position that device 100 may be stabilized in preparation forclosing access passageway 130.

As shown in FIGS. 3A and 6C, needle advancement assembly may beactivated (e.g., by pressing lever 122). This action deploys hollowneedles 112 a and 112 b through ports 120 a and 120 b, as well asthrough hemostatic plugs 124 a and 124 b disposed thereover. The hollowneedles 112 a, 112 b are deflected, deploying through the tissue 140adjacent passageway 130 and through the wall 142 of body lumen 134.Hollow needles 112 a and 112 b provide access into body lumen 134through which a suture and associated suture-anchor may be introducedfor closing access passageway 130.

As shown in FIGS. 3B and 6D, the suture-anchor ejection assembly may beactivated (e.g., by pressing lever 123), causing advancement ofsuture-anchor ejection mandrels 116 a and 116 b within hollow needles112 a and 112 b. As shown in FIG. 6D, during this ejection procedure,hollow needles 112 a and 112 b may remain deployed (e.g., lever 122remains depressed or otherwise activated). Mandrels 116 a and 116 b pushbefore them suture-anchors 125 a and 125 b, so as to push suture-anchors125 a and 125 b out hollow needles 112 a and 112 b into body lumen 134.

Suture-anchors 125 a and 125 b may be configured to be deployed intobody lumen 134 and abut internal wall 142 of lumen 134. For example,suture-anchors 125 a and 125 b may be elongated with a cross-sectionsufficiently small to pass through hollow needles 112 a, 112 b (e.g.,pushed by mandrels 116 a, 116 b), but with a dimension sufficient tobridge the lumen of hollow needles 112 a, 112 b once rotated afterdeployment. FIG. 6E shows suture-anchors 125 a, 125 b in a deployedconfiguration, so that their longitudinal dimension (which is longerthan their transverse width) is transverse to hollow needles 112 a, 112b and mandrels 116 a, 116 b. Suture-anchors 125 a and 125 b may bedeployed in this configuration by simply applying slight tension tosutures 118 a and 118 b, the distal ends of which are attached tocorresponding suture-anchors 125 a and 125 b. For example, in anembodiment the sutures 118 a, 118 b may be attached to a side of thecorresponding suture-anchor so that as the suture anchor is pushedthrough the corresponding hollow needle, it maintains its longitudinalorientation.

Because of the attachment point of suture 118 a, 118 b with thecorresponding suture-anchor, once the suture-anchor exits the hollowneedle and tension is applied to the suture, the suture anchor mayrotate or “gimbal” to assume a rotated (e.g., 90°) orientation. In therotated configuration, the major surface area surface of thesuture-anchor can be pulled up, adjacent the wall 142 of the body lumen134. For example, the proximal ends of sutures 118 a, 118 b may beaccessible to the practitioner through the proximal end 104 of device100. By tensioning sutures 118 a, 118 b and slightly retracting device100 while maintaining activation of the suture-anchor ejection assembly,the suture-anchors 125 a and 125 b can be engaged against wall 142 ofbody lumen 134.

Additional detail of exemplary suture-anchors and their attachment tosutures may be found in U.S. patent application Ser. Nos. 12/684,400,12/684,542, 12/684,569, 12/684,562, 12/684,470, 13/112,618, and13/112,631. Each of the above patent applications claim priority to U.S.Provisional Patent Application No. 61/143,751. Each of the aboveapplications is incorporated herein by reference, in its entirety.

Hemostatic plugs 124 a, 124 b may comprise any suitable material. In anembodiment, such plugs comprise collagen. In another embodiment, suchplugs may comprise one or more polymers, such as PEG. Bioabsorbablepolymers may be suitable for use (e.g., polylactic acid, polyglycolicacid, copolymers thereof, etc.). Hemostatic plugs 124 a, 124 b may beswellable, so as to swell as they absorb blood, water, or body fluidspresent.

Suture-anchors 125 a, 125 b may comprise any suitable material. In anembodiment, such suture-anchors may be bioabsorbable. As suture-anchorsremain behind within body lumen 134, the suture-anchor may comprise arapidly-eroding material, so as to erode or dissolve within the bodylumen 134 within a matter of hours. In an embodiment, therapidly-eroding material may be a surface eroding material. Inparticular, the rapidly-eroding material may dissolve from the outerlayer inward, thereby preserving the strength of the core of therapidly-eroding material during the initial stages of dissolution. Inone embodiment, this may be similar to the dissolution of a hard candy,wherein dissolution occurs at the outer surface, one layer at a time,rather than dissolving from within.

The rapidly-eroding material may include, in one example embodiment, oneor more sugars, such as glucose or sucrose. In a further embodiment,additional materials may be added to the rapidly-eroding material toprovide additional properties to the rapidly-eroding material. Forexample, a poly-vinyl pyrrolidone or similar material may be added toenhance toughness, a hyaluronic acid, dextran, and/or similar materialsmay be added to increase hemocompatibility and thromboresistance, and/orbeneficial agents, such as anti-inflammatories, can be added to reducelocal scar formation. Heparin may also be added to the rapidly-erodingmaterial when compatible processing temperatures are employed. In afurther embodiment, the rapidly-eroding material may include ahydrogel-like material. In a yet further embodiment, the rapidly-erodingmaterial may be coated with a heparin surface treatment, such asbenzalkonium heparin.

In one embodiment, the rapidly-eroding material can be configured to beat least partially porous and/or micro-porous. Accordingly, one or morebeneficial agents can be incorporated into at least one of the pores ofthe rapidly-eroding material. For example, the beneficial agents mayinclude anti-clotting agents, such as heparin, anti-inflammatory agents,and/or other beneficial agents. One method for producing a porousrapidly-eroding material may include freeze drying the rapidly-erodingmaterial. In particular, in one example embodiment, acetic acid may beused as a solvent for freeze drying the rapidly-eroding material.Polymers, such as PLGA, which are soluble in acetic acid, may be used aspart of the freeze-drying process.

In a further embodiment, a micro-porous silicon may be used. Inparticular, the micro-porous silicon may be prepared with variousdegradation rates, including rapidly degrading forms. The micro-poroussilicon may be sufficiently strong to be used in a suture-anchor, and/ormay also have sufficient porosity to allow incorporation of beneficialagents. For example, in one embodiment, it may be desirable toincorporate a hydrophobic heparin derivative, such as benzalkoniumheparin, into the porosity of the suture-anchor because of its lowsolubility.

In a yet further embodiment, the suture-anchor may comprise a nanomaterial (e.g., peptides). Once a suture-anchor is deployed within alumen, the nano-material may dissolve into the fluid flow within thelumen. In particular, the suture-anchor may be configured to dissolveand/or disappear once the suture-anchor is no longer needed.

As seen in FIG. 7A, once suture-anchors 125 a, 125 b are engaged againstwall 142, the proximal portion 107 of device 100, including levers 122and 123, as well as associated hollow needles 112 a, 112 b, andsuture-anchor ejection mandrels 116 a, 116 b activated thereby can beretracted from the remaining distal portion 109 of housing 102 of device100. For example, body 102 may include proximal and distal housingportions 107 and 109 which are detachable from one another. For example,the proximal housing portion 107 may slide over the distal housingportion 109, as shown. Any desired retention mechanisms (e.g., détentes,couplings, etc.) may be included to initially couple the two portionstogether and prevent inadvertent premature separation of the proximalhousing portion from the distal housing portion. In an embodiment, anycoupling of the two portions may be such that upon separation, theseparation is irreversible (e.g., breaking or fracture of a couplingmechanism). In another embodiment, the coupling mechanism may allowrecoupling of the separated portions (i.e., separation may bereversible).

As the proximal portion 107 of the device 100 is removed, sutures 118 aand 118 b remain behind, with distal portion 109 of device 100. As seenin FIG. 7B, the distal portion 109 of device 100, including attachedneedle guide 110 and sheath 108, may then be partially retracted fromaccess passage 130 so that sheath 108 maintains hemostasis of accesspassage 130, while the proximal legs of sutures 118 a and 118 b areharvested from needle ports 120 a and 120 b (e.g., by pulling sutures118 a and 118 b laterally outward as indicated by the arrows in FIG.7B).

As described above, the adherence strength of hemostatic plugs 124 a and124 b within recesses 126 a and 126 b may be such that penetration ofhemostatic plugs 124 a, 124 b by needles 112 a, 112 b is sufficient todislodge plugs 124 a, 124 b from recesses 126 a, 126 b. As a result,when distal portion 109 is partially retracted as seen in FIG. 7B,hemostatic plugs are retained at the location within access passage 130where they were penetrated by needles 112 a and 112 b. Although needles112 a and 112 b have been retracted as seen in FIG. 7B, sutures 118 aand 118 b maintain in their prior position, passing through plugs 124 aand 124 b, and helping to retain plugs 124 a and 124 b in place asneedles 112 a and 112 b are retracted.

In an embodiment, sutures 118 a and 118 b may include at least a portionthereof that is specially configured to aid in retaining hemostaticplugs 124 a and 124 b in place. For example, FIGS. 8A and 8B illustratea suture 118 including one or more barbs 144 configured to resistproximal movement of plugs 124 a, 124 b once suture 118 is engagedtherewith. Adjacent portions of suture 118, away from plugs 124 a, 124b, may be smoother than the barbed section. Illustrated barbs 144include a wider distal dimension or ledge, which tapers to a smallerproximal dimension. The illustrated barb configuration is merelyexemplary, and other configurations may also be suitable for use. Inanother embodiment, suture 118 may be etched or otherwise chemically ormechanically treated (e.g., by abrasion) to provide a roughened surfaceto at least a portion of suture 118, providing a similar retentioncharacteristic. As employed herein, the term “barbed” as relating to thesuture is to be broadly construed to encompass such treatments ormanufacturing techniques resulting in a roughened surface.

In an embodiment, barbs may similarly be provided on hollow needles 112a, 112 b in order to aid in dislodging and pushing hemostatic plugs 124a, 124 b from receiving recesses 126 a, 126 b. Such barbs may also beprovided on suture-anchors 125 a, 125 b. FIG. 8C illustrates anembodiment where suture-anchors 125 a and 125 b each include one or morebarbs 127 a, 127 b, respectively, to aid in stabilization. For example,the surface of each suture-anchor that becomes oriented in apposition tobody lumen (e.g., artery) wall 142 may include one or more barbs forengagement with wall 142, stabilizing the suture-anchor in the desiredorientation and position.

The suture-anchors may be of a one-piece type construction, or maycomprise two or more pieces joined (e.g., mechanically) together. Thesuture-anchors may vary in length, mass, or other characteristics tofacilitate ejection and gimballing.

As seen in FIG. 9A, a surgical knot (e.g., such as the surgical slidingknot shown) may be tied, and device 100 may be fully retracted fromaccess passage 130 as the knot is advanced (FIG. 9B), pulling tissue 142in apposition, closing passage 130. Because of the presence ofhemostatic plugs 124 a and 124 b engaged on suture legs 118 a and 118 b,a secondary sealing mechanism is provided through the hemostatic plugmaterial, providing a more effective closure of opening 130 as comparedto suture or a hemostatic plug alone.

The present invention may be embodied in other specific forms withoutdeparting from its spirit or essential characteristics. The describedembodiments are to be considered in all respects only as illustrativeand not restrictive. The scope of the invention is, therefore, indicatedby the appended claims rather than by the foregoing description. Allchanges which come within the meaning and range of equivalency of theclaims are to be embraced within their scope.

What is claimed is:
 1. A method of closing an opening in tissue, themethod comprising: advancing a suture-anchor through the tissue;positioning a plug adjacent the opening, the suture-anchor beingadvanced through the plug prior to being advanced through the tissue;and securing the plug to the tissue, wherein, positioning the plugadjacent the opening comprises disposing the plug within an accesspassage, the plug extending generally parallel to the access passage,and then transitioning the plug to extend generally transversely to adirection of elongation of the access passage.
 2. The method of claim 1,further comprising advancing the suture-anchor through another tissuethrough which an access passage is formed.
 3. The method of claim 1,wherein securing the plug comprises advancing a knot along a sutureextending proximally from the suture-anchor.
 4. The method of claim 1,advancing a hollow needle through the tissue, the suture-anchor beingadvanced from the hollow needle.
 5. The method of claim 1, whereinpositioning the plug adjacent the opening comprises deploying the plugfrom a recess of a needle guide.
 6. The method of claim 5, furthercomprises advancing a hollow needle from a needle port of the needleguide.
 7. The method of claim 1, wherein the plug is bioabsorbable. 8.The method of claim 1, wherein the suture-anchor is bioabsorbable.
 9. Amethod of closing an opening in tissue, the method comprising: deployinga plurality of one-piece suture-anchors into the tissue near theopening, each suture-anchor comprising an elongate body with a pluralityof stabilizing members, the plurality of stabilizing members extendingproximally in a deployed state; positioning a plurality of plugsadjacent the opening, each one-piece suture-anchor being advancedthrough one plug of the plurality of plugs prior to being advancedthrough the tissue, positioning the plurality of plugs adjacent theopening comprises disposing each plug within an access passage, eachplug extending generally parallel to the access passage; and distallyadvancing a knot in suture associated with the plurality of one-piecesuture-anchors to pull the tissue into apposition, closing the opening,distally advancing the knot transitioning each plug to extend generallytransversely to a direction of elongation of the access passage.
 10. Themethod of claim 9, further comprising moving the plurality of one-piecesuture-anchors towards the opening as the knot is distally advanced. 11.The method of claim 9, further comprising proximally moving a mandrelassociated with each one-piece suture-anchor to advance each one-piecesuture-anchor into the tissue.
 12. The method of claim 11, whereindeploying the plurality of one-piece suture-anchors comprises actuatinga lever to distally advance a plurality of mandrels associated with theplurality of one-piece suture-anchors.
 13. The method of claim 9,wherein a one-piece suture-anchors of the plurality of one-piecesuture-anchors is rotatable relative to the suture.
 14. The method ofclaim 9, wherein the plurality of stabilizing members are a plurality ofbarbs.
 15. The method of claim 9, further comprising advancing adelivery device towards the tissue, the delivery device comprising aplurality of lumens each accommodating one of the plurality of one-piecesuture-anchors.
 16. The method of claim 15, wherein deploying theplurality of one-piece suture-anchors further comprises actuating alever to advance the plurality of one-piece suture-anchors through theplurality of lumens.
 17. The method of claim 16, wherein deploying theplurality of one-piece suture-anchors comprises penetrating the tissuewith a plurality of hollow needles before deploying the plurality ofone-piece suture-anchors toward the tissue.
 18. The method of claim 9,wherein deploying the plurality of one-piece suture-anchors comprisesdeploying the plurality of one-piece suture-anchors at an angle into thetissue.